Healthcare Provider Details

I. General information

NPI: 1457417511
Provider Name (Legal Business Name): ALFRED ERNEST TOLES JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6875 SHERWICK DR
BERKELEY CA
94705-1744
US

IV. Provider business mailing address

6875 SHERWICK DR
BERKELEY CA
94705-1744
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-6302
  • Fax:
Mailing address:
  • Phone: 510-845-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW4590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: